What are some ways to increase compliance of VTE Prophylaxis as well as barriers?

Posted on December 17, 2013 by John

Biffl WL et al. ““Leaning” the process of venous thromboembolism prophylaxis.” The joint commission journal on quality and patient safety 37.3 (2011):99.

Tiryaki, Funda ; Nutescu, Edith A. ; Hennenfent, Joel A. ; Karageanes, Annette M. ; Koesterer, Larry J. ; Lambert, Bruce L. ; Schumock, Glen T.Anticoagulation therapy for hospitalized patients: Patterns of use, compliance with national guidelines, and performance on quality measures. American Journal of Health-System Pharmacy, 2011 Jul 1; 68 (13): 1239-44.

Wang Z et al.”Compliance with surgical care improvement project measures and hospital-associated infections following hip arthroplasty.” Journal of Bone and Joint Surgery; American volume 94.15 (2012):1359.

Brown, Alexandra Preventing venous thromboembolism in hospitalized patients with cancer: Improving compliance with clinical practice guidelines.
American Journal of Health-System Pharmacy, 2012 Mar 15; 69 (6): 469-81.

Li F ; Walker K ; McInnes E ; Duff J Testing the effect of a targeted intervention on nurses’ compliance with “best practice” mechanical venous thromboembolism prevention. Journal of Vascular Nursing, 2010 Sep; 28 (3): 92-6.

Gaston, Sherryl ; White, Sarah louise Venous thromboembolism ( VTE) risk assessment: Rural nurses’ knowledge and use in a rural acute care hospital. International Journal of Nursing Practice, 2013 Feb; 19 (1): 60-4.

Gaston, Sherryl, White, Sarahlouise, Misan, Gary. Venous Thromboembolism (VTE) Risk Assessment and Prophylaxis: A Comprehensive Systematic Review of the Facilitators and Barriers to Healthcare Worker Compliance with Clinical Practice Guidelines in the Acute Care Setting. The JBI Library of Systematic Reviews. 10(57):3812-3893, 2012.

Databases: CINAHL and Joanna Briggs. Keywords: VTE, Venous Thromboembolism, compliance, barriers

Reviewed by John Nemeth 4/14

What is the effectiveness of sitters for preventing patient falls?

Posted on December 4, 2013 by John

Adams, Jewel, and RobertaKaplow. “A sitter-reduction program in an acute health care system.” Nursing economic$ 31.2 (2013):83-89.

Spiva, LeeAnna, et al. “An evaluation of a sitter reduction program intervention.” Journal of nursing care quality 27.4 (2012):341-345.

Tzeng, Huey-Ming, Chang-YiYin, and JulieGrunawalt. “Effective assessment of use of sitters by nurses in inpatient care settings.” Journal of advanced nursing 64.2 (2008):176-183.

Harding, Andrew D. “Observation assistants: sitter effectiveness and industry measures.” Nursing economic$ 28.5 (2010):330-336.

“Falls/ambulation: Reducing sitter use: Decision outcomes.” Nursing Management 42.12 (2011):37.

Searched CINAHL and PubMed. Keywords: sitter and (fall or falls)

Reviewed by John Nemeth 4/14

What is the standard of care for the post-operative patient who received spinal anesthesia?

Posted on October 31, 2013 by John

Searches of PubMed, The Joanna Briggs Institute EBP Database, and the National Guideline Clearinghouse yielded the following practice guideline.

Whitaker Chair, D K, et al. “Immediate post-anaesthesia recovery 2013: Association of Anaesthetists of Great Britain and Ireland.” Anaesthesia 68.3 (2013):288-297.

The abstract states, “The standard of nursing and medical care should be equal to that in the hospital’s critical care units.”

Reviewed 4/8/2014 ldt

Is there benefit to routinely screening for urinary tract infection (bacteruria) in hospitalized patients without urinary catheters?

Posted on August 15, 2013 by Amy

The information below pertains to asymptomatic bacteruria because the assumption is if the patient were symptomatic, diagnostic testing would be administered as standard care for the patient.

Here are guidelines for diagnosing and managing asymptomatic bacteruria.

Infectious Diseases Society of America (IDSA) guideline on diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005 Mar 1;40(5):643.
- Based on evidence from at least 1 quality RCT in each case, IDSA recommends AGAINST screening premenopausal, nonpregnant women, women with diabetes, elderly institutionalized persons, older persons living in community, patients with spinal cord injury, patients with indwelling urethral catheter. Also recommends screening pregnant women.
- IDSA does recommend screening prior to transurethral resection of prostate (based on at least 1 RCT) and before other urologic procedures (based on descriptive studies and expert opinion)
- IDSA does not make any recommendation about screening renal or other solid organ transplant recipients

United States Preventive Services Task Force (USPSTF) recommendation on screening for asymptomatic bacteriuria in adults. National Guideline Clearinghouse 2008 Aug 4:12619 or Ann Intern Med 2008 Jul 1;149(1):43.
- Only recommends routine screening for pregnant women.

Guidelines suggest further research is needed to address management of asymptomatic bacteruria in these populations: chronic kidney disease, indwelling urinary devices other than catheters (eg, urinary stents, nephrostomy tubes), selected immunocompromised patients (eg, neutropenia, transplant recipients), and patients undergoing prosthetic implantation (orthopedic or vascular procedures).

Evidence from the guidelines includes hospitalized and non-hospitalized patients. Details of the evidence are provided in the guidelines.

Searches of Medline and CINAHL using combinations of these terms did not identify any papers on routine testing of hospitalized patients.

Urine analysis
Routine, screening
Hospitalized, inpatients
Transplant, immunocompromised

Nursing care for a patient with externalized shunt

Posted on August 9, 2013 by John

Hill, Michelle A multidisciplinary approach to end external ventricular drain infections in the neurocritical care unit. Journal of Neuroscience Nursing, 2012 Aug; 44 (4): 188-93.

Henman, Lita Checklists and Bundles-Not Just for Central Lines Anymore: Using a Standardized Insertion and Maintenance Approach to Eliminate External Ventricular Drain Infections. American Journal of Infection Control, 2011 Jun; 39 (5): E195.

Orsi GB Hospital-acquired infection surveillance in a neurosurgical intensive care unit. Journal of Hospital Infection, 2006 Sep; 64 (1): 23-9.

Cummings R Understanding external ventricular drainage. Journal of Neuroscience Nursing (J NEUROSCI NURS), 1992 Apr; 24 (2): 84-7.

Lwin, Sein, et al. “External ventricular drain infections: successful implementation of strategies to reduce infection rate.” Singapore medical journal 53.4 (2012):255-259.

Littlejohns, Linda R, and BrettTrimble. “Our policy on external ventricular drainage systems includes the procedure for priming the system. Does it really have to be primed?.” Critical care nurse 25.3 (2005):57-59.

Criddle, Laura M. “Is it an expected practice for critical care nurses to irrigate an external ventriculostomy drainage (EVD) system with tissue plasminogen activator (tPA) to break up blood clots in the tubing to facilitate drainage, thereby preventing increased intracranial pressure?.” Critical care nurse 27.3 (2007):78-78, 81.

Searched PubMed & CINAHL. Keywords: external shunt, externalized shunt, (nursing or nurse)

What are the evidence-based recommendations for orientation time for new graduate nurses in terms of safety and readiness to practice?

Posted on June 25, 2013 by carolynmbrown

Search was done in PubMed and Joanna Briggs using these search terms: new graduate nurses AND (transition OR residency OR internship).

Bottom Line: Literature search revealed very broad time line in nurse residency from 6 weeks to one year and time by (department or area not discussed).
Park, Mihyun, and Cheryl B Jones. A retention strategy for newly graduated nurses: an integrative review of orientation programs. Journal for nurses in staff development 26.4 (2010):142-149. See TABLE 1 The Summary of Program Outcomes

Holland, Cindra, and Gail RModdeman. Transforming the journey for newly licensed registered nurses. The Journal of Continuing Education in Nursing 43.7 (2012):330-336.

Kramer, Marlene, et al. The organizational transformative power of nurse residency programs. Nursing administration quarterly 36.2 (2012):155-168.

Purling, Amy, and LindyKing. A literature review: Graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of clinical nursing 21.23-24 (2012):3451-3465.

The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse. (Systematic Review). The JBI Library of Systematic Reviews & Implementation Reports. 9(53):2215-2323, 2011.

More references from PubMed

Overview of peripherally inserted central catheters and central venous catheters

Posted on June 21, 2013 by John

Go to Joanna Briggs and cut and paste the following phrases into the search box:
peripherally inserted central catheter
central venous catheter

Egan GM ; Siskin GP ; Weinmann R 4th ; Galloway MM. A Prospective Postmarket Study to Evaluate the Safety and Efficacy of a New Peripherally Inserted Central Catheter Stabilization System. Journal of Infusion Nursing, 2013 May-Jun; 36 (3): 181-8

Beghetto MG ; Victorino J ; Teixeira L ; de Azevedo MJ Parenteral nutrition as a risk factor for central venous catheter-related infection.
JPEN Journal of Parenteral & Enteral Nutrition, 2005 Sep-Oct; 29 (5): 367-73.

Baiocco, Graziella Gasparotto ; da Silva, Jefferson Luis Braga The Use of the Peripherally Inserted Central Catheter (Pice) in the Hospital Environment. Revista Latino-Americana de Enfermagem (RLAE) (REV LAT AM ENFERMAGEM), 2010 Nov-Dec; 18 (6): 1131-7.

Databases searched: Joanna Briggs, CINAHL, MDConsult. Keywords: peripherally inserted central catheter, central venous catheter, indications

Evidence Matters

Evidence-based information for Emory

Category Archives: Patient Safety